Organization
MANCERA DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER KRAUSHAAR (PROVIDER RELATIONS REP)
(315) 454-6000
Entity
Organization
Contact information
Practice address
281 SANDERS CREEK PKWY, EAST SYRACUSE, NY 13057-1307
(315) 454-6000
(866) 803-4943
Mailing address
640 W KARSCH BLVD, FARMINGTON, MO 63640-3342
(573) 705-3485
(573) 747-0058
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2015041029
MO
Other
Enumeration date
03/17/2017
Last updated
03/17/2017
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